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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

Claim of Fuentes v. New York City Housing Authority

This case concerns an appeal by the Special Fund for Reopened Cases from a Workers’ Compensation Board decision dated November 15, 2006. The Board had transferred liability for a claimant's 1998 work-related back injury to the Special Fund, pursuant to Workers’ Compensation Law § 25-a. The Special Fund argued that certain payments made to the claimant in late 2005, between November 30 and December 17, were advance payments of compensation, which would preclude the transfer of liability. However, the Board found that these payments were charged to the claimant's accumulated sick leave and did not constitute advance payments of compensation. The court affirmed the Board's finding, concluding that the sick leave payments did not prevent the transfer of liability to the Special Fund because they were not made voluntarily in recognition of employer liability, and thus, the criteria for transferring liability to the Special Fund were met.

Special Fund for Reopened CasesWorkers' Compensation Law Section 25-aAdvance Payments of CompensationSick Leave PlanLiability TransferStale ClaimApplication to Reopen ClaimWork-Related InjuryBack InjuryTreating Physician Report
References
7
Case No. MISSING
Regular Panel Decision
Apr 26, 2013

Claim of Khomitch v. Crotched Mountain Community

Claimant was injured in 2004 and received compensation through February 2007. In 2011, she sought reimbursement for medical bills and lost wages, leading to a stipulation where the carrier paid $4,750 for medical and transportation expenses (M&T). The carrier then sought to transfer liability to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a. The Special Fund argued the M&T payment was disguised compensation to improperly trigger the liability transfer. The Board Panel, after remittal, concluded that the Special Fund has standing to litigate if the payment was an advance payment of compensation. The Board rescinded the liability transfer to the Special Fund, without prejudice, pending further evidence. The employer and carrier appealed this decision, which was ultimately affirmed.

Workers' Compensation BoardSpecial Fund for Reopened CasesTransfer of LiabilityWorkers' Compensation Law § 25-aMedical and Transportation ExpensesAdvance Payment of CompensationStanding to LitigateClosed Case ReopeningIndemnity BenefitsBoard Panel Decision
References
7
Case No. MISSING
Regular Panel Decision

Claim of Porter v. New York State Electric & Gas Corp.

The claimant, who sustained head, neck, and back injuries in 2004, had a workers' compensation case established for occupational disease, with 22.5% liability for neck and back injuries apportioned to the incident. After experiencing continued back problems and being diagnosed with severe biforaminal stenosis, the Chair authorized an MRI in 2010 and lumbar spine surgery in 2011. The workers’ compensation carrier sought to transfer liability to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a, a request initially denied by a WCLJ but granted by the Board, which found the April 27, 2011 order authorizing surgery constituted a 'true closing' of the case. The Special Fund appealed the Board's decision, arguing against the transfer of liability. The appellate court affirmed the Board's decision, concluding that substantial evidence supported the finding that the case was truly closed, thereby shifting liability to the Special Fund.

Workers' Compensation Law § 25-aSpecial Fund for Reopened CasesLiability ShiftClosed CaseTrue ClosingMedical AuthorizationLumbar Spine SurgeryCervical Spine MRIOccupational DiseaseApportionment
References
8
Case No. MISSING
Regular Panel Decision

Claim of Lauritano v. Consolidated Edison Co.

This case involves an appeal from a Workers’ Compensation Board decision regarding the transfer of liability to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a. The claimant suffered a work-related heart attack in 1992, received benefits, and the case was closed in 1997. After another heart attack and surgery in 1999, the claim was reopened in 2001. A Workers’ Compensation Law Judge initially found it was not a stale claim, but the Board reversed, transferring liability to the Special Fund. The Special Fund argued that employer payments for lost time in 1999-2000 constituted advance payments of compensation, precluding transfer. However, the court affirmed the Board's determination that these payments, made pursuant to a general sick leave plan, did not qualify as advance payments of compensation under § 25-a, thus supporting the transfer of liability to the Special Fund.

Special Fund for Reopened CasesWorkers' Compensation Law Section 25-aStale Claim DoctrineAdvance Payments of CompensationSick Leave BenefitsLiability TransferHeart Attack InjuryReopened CaseAppellate Review of Board DecisionSubstantial Evidence Standard
References
4
Case No. MISSING
Regular Panel Decision

Matter of Bank v. Village of Tuckahoe

The Workers' Compensation Board ruled that liability for a claimant's left knee injury shifted to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a. The claimant sustained a work-related injury in June 2005, and compensation benefits were paid until June 20, 2005. In April 2012, a physician requested an MRI, which was performed and revealed a meniscal tear. Subsequently, surgery was authorized and performed in July 2012. The self-insured employer and its third-party administrator sought to shift liability to the Special Fund, a move initially rejected by a Workers' Compensation Law Judge but later approved by the Board. The Special Fund appealed the Board's decision. The appellate court reversed the Board's decision, finding that the case was not "truly closed" after the MRI request was approved. The court held that the case was reopened in April 2012, within the statutory seven-year period from the date of injury, thus precluding the shifting of liability to the Special Fund. The matter was remitted to the Board for further proceedings.

Workers' Compensation Law § 25-aSpecial Fund LiabilityReopened Case DoctrineMedical Treatment AuthorizationCase Closure DeterminationSeven-Year RuleLast Payment of CompensationMeniscal TearMRI AuthorizationSurgery Authorization
References
5
Case No. MISSING
Regular Panel Decision
Feb 08, 2013

Claim of Pankiw v. Eastman Kodak Co.

The case involves an appeal from a Workers’ Compensation Board decision regarding the shifting of liability to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a. Claimant, who suffered work-related injuries in 2004, had a 20% schedule loss of use of his left arm opined in 2007, and a consequential right shoulder injury was added in 2008 with a 30% schedule loss of use, for which the Special Fund became liable. In 2011, claimant sought further action, leading a WCLJ to transfer liability to the Special Fund. However, the Board reversed, finding the case was not "truly closed" because the issue of the left arm injury remained unaddressed. The Appellate Division affirmed the Board's decision, holding that the lack of resolution on the left arm injury meant further proceedings were contemplated, thus preventing the case from being deemed truly closed for liability transfer to the Special Fund.

Workers' CompensationSpecial Fund for Reopened CasesSchedule Loss of UseConsequential InjuryCase ClosureLiability ShiftAppellate DivisionFactual DeterminationCompensation PaymentsUnaddressed Issues
References
5
Case No. 10-93-224-CV
Regular Panel Decision
May 18, 1994

Subsequent Injury Fund of the State of Texas (Formerly the Second Injury Fund) v. Larry Milligan

The Subsequent Injury Fund appeals a judgment awarding Larry Milligan lifetime benefits for injuries sustained at work. Milligan suffered two ankle injuries in 1987 and a third in 1989, leading to the total loss of use of both feet. He sued the Fund for lifetime benefits after settling with the workers' compensation carrier. The jury found permanent, total loss of use of both feet. The Fund challenged its statutory liability for lifetime benefits and the court's refusal to submit a jury question on total and permanent incapacity. The appellate court affirmed, finding the first issue unpreserved and the second resolved by a statutory conclusive presumption of total and permanent incapacity for the loss of both feet.

Workers' Compensation LawSubsequent Injury FundLifetime BenefitsTotal Permanent IncapacityAnkle InjuriesStatutory InterpretationAppellate ReviewJury InstructionsConclusive PresumptionOccupational Injuries
References
6
Case No. MISSING
Regular Panel Decision
Mar 12, 2001

Mason Tenders District Council Welfare Fund v. Thomasen Construction Co.

The case involved a dispute between the Mason Tenders District Council Welfare Fund and Mason Tenders District Council (plaintiffs) and Thomsen Construction Company, Inc., along with its owner, Stephen Thomsen (defendants). While Thomsen Construction conceded liability for failing to make contributions to the Funds, the central issue was whether Stephen Thomsen could be held personally liable. The court applied New York law concerning an agent's personal liability, which requires clear and explicit evidence of intent to assume personal liability, and considered factors such as contract negotiation and the signatory's role. The court found that the personal liability clause was not negotiated, and Thomsen signed in his official capacity as president, intending to avoid personal liability through incorporation. Consequently, the court ruled that Stephen Thomsen was not personally liable, entering judgment in his favor, although judgment was entered against Thomsen Construction, Inc.

Labor LawEmployee BenefitsERISALMRACorporate LiabilityPiercing the Corporate VeilContract LawAgency LawNew York LawFederal Jurisdiction
References
6
Case No. M2004-01683-WC-R3-CV
Regular Panel Decision
Sep 22, 2005

Larry Hopper v. Oshkosh B'Gosh And State of Tennessee, Department of Labor, Division of Workers' Compensation, Second Injury Fund

Larry Hopper, employed by OshKosh B’Gosh, sustained a back injury in 1996 and settled the workers' compensation claim for 20% vocational disability in 1997. After losing his job, he sought to reopen the settlement, filing a motion for reconsideration against the Second Injury Fund only. The trial court granted this, increasing his vocational disability by 30% and assigning liability to the Second Injury Fund. On appeal, the Special Workers’ Compensation Appeals Panel reversed the trial court's decision, finding that the Second Injury Fund's liability is limited to subsequent compensable injuries, not the initial injury for which reconsideration was sought. Therefore, Mr. Hopper’s claim against the Second Injury Fund for a first injury reconsideration was deemed to lack standing and was dismissed.

Workers' CompensationSecond Injury FundVocational DisabilityReconsideration of SettlementStatute of LimitationsSubject Matter JurisdictionAppellate ReviewStatutory ConstructionPre-existing InjuryEmployer Liability
References
11
Case No. MISSING
Regular Panel Decision

Faison v. City of New York Department of Human Resources

The case concerns an appeal from decisions of the Workers’ Compensation Board regarding liability for a claimant’s reopened case. The claimant sustained a permanent partial disability in 1991 and her case was closed in 1993. In 2001, she applied to reopen it. A Workers’ Compensation Law Judge and subsequently a Board panel found that the employer voluntarily made advance payments of compensation within three years of the application, thereby making the employer, not the Special Fund for Reopened Cases, liable for disability payments. The employer appealed this decision. The appellate court examined whether the employer's payment of wages, deducted from sick leave, constituted an 'advance payment of compensation' with an acknowledgment of liability. The court found that wages paid from sick leave are not advance payments of compensation, and there was no substantial evidence that the employer’s payments were made voluntarily in recognition of continuing liability. Therefore, the Board's decision was reversed, and liability was transferred to the Special Fund for Reopened Cases.

Permanent Partial DisabilityReopened CaseAdvance Payments of CompensationSick LeaveEmployer LiabilitySpecial Fund for Reopened CasesWorkers' Compensation Law § 25-aAppellate ReviewSubstantial EvidenceRemittitur
References
8
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